Tier 1—Deaths—1.20 Infant and child mortality

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Infant mortality is the death of a child less than one year of age and is a long-established measure of child health, as well as the overall health of the population and its physical and social environment. COAG has committed to halving the gap in mortality rates for Aboriginal and Torres Strait Islander children under 5 years by 2018. During the period 2006–10, infant mortality contributed 83% of mortality for children less than 5 years of age.

Improvements in Australia's infant mortality rates in the last 100 years were largely due to improved social and public health conditions such as sanitation and health education in the first half of the twentieth century, followed by the development of immunisation, and in more recent years by better treatment in neonatal intensive care and interventions for Sudden Infant Death Syndrome (SIDS).

In the Aboriginal and Torres Strait Islander population, dramatic reductions in post-neonatal infant mortality (such as in the NT in the 20 years up to the late 1980s), reflected improved access to primary health care (including antibiotics for acute infection) and earlier evacuation to hospital for severe illness.

Findings:

Reliable data on child mortality for Aboriginal and Torres Strait Islander peoples are available for NSW, Qld, WA, SA and the NT. In the period 2006–10, there were 645 deaths of Aboriginal and Torres Strait Islander children aged 0–4 years, and of these 533 were infant deaths (83%). The mortality rate for Aboriginal and Torres Strait Islander children aged 0–4 years was twice the non-Indigenous rate. The mortality rate for Indigenous infants was also twice the non-Indigenous rate (8&nbspper 1,000 live births compared with 4&nbspper 1,000 live births). Aboriginal and Torres Strait Islander infant mortality rates varied across jurisdictions, from 6&nbspper 1,000 in SA, to 13 per 1,000 in the NT.

The most common causes of death for Aboriginal and Torres Strait Islander infants were conditions originating in the perinatal period (50%) such as birth trauma, foetal growth, complications of pregnancy, and respiratory and cardiovascular disorders specific to the perinatal period. The second leading cause of death was congenital malformations accounting for 16% of infant deaths. The third most common cause was signs, symptoms and ill-defined conditions (14%). This category includes SIDS which accounted for 8% of infant deaths.

Data on long-term time-trends are available for WA, SA and the NT. For these three jurisdictions, the Aboriginal and Torres Strait Islander infant mortality rate declined between 1991 and 2010 by 62%, compared with a reduction of 43% for non-Indigenous infants. The gap between Indigenous Australians and non-Indigenous Australians closed significantly in both absolute (67%) and relative (35%) terms. Recent trends (2001–10) for NSW, Qld, WA, SA and the NT show a 46% decline in Indigenous infant mortality rates. Over this period the gap in rates between Indigenous and non-Indigenous Australians declined from around 6 to 4 infant deaths per 1,000 live births. Trends for children aged 0–4 years followed a similar pattern, although the decline in rates for Indigenous children was slower. Data on trends from 1967 to 2006 in the NT (the only jurisdiction with adequate data quality for this period) show an 81% fall in the Aboriginal and Torres Strait Islander infant mortality rate with rapid declines until the mid-1980s, followed by slower improvement over the past 20 years. There has been substantial improvement in the NT for both neonatal death rates (up to age 20 days) and post-natal death rates (from 28 days to one year) (Wang et al. 2010b).

International statistics show that indigenous infants in the US and New Zealand have higher mortality rates than infants in the general population but the gap is not as great as for Aboriginal and Torres Strait Islander infants. In New Zealand the infant mortality rate for Maoris was 6 per 1,000 live births compared with 4 per 1,000 for other New Zealanders in 2010. In the United States, the mortality rate for American Indians/Alaskan Natives was 9 per 1,000 live births compared with 7 per 1,000 live births for the total population in 2007.Top of page

Implications:

Both child and infant mortality rates for Aboriginal and Torres Strait Islander peoples are declining. While mortality for other Australian children is also declining, the gaps in mortality between Aboriginal and Torres Strait Islander and other Australian infants and children are reducing in both absolute and relative terms. Deaths during the neonatal period, which account for 63% of infant deaths, have also been significantly improving (see measure&nbsp1.21).

This significant improvement provides opportunities to understand which aspects of Aboriginal and Torres Strait Islander lives contributed and where the health system could be more effective in engaging with Aboriginal and Torres Strait Islander peoples and their families to support healthy pregnancies and childhood development.

Low birthweight among Aboriginal and Torres Strait Islander babies has also decreased in recent years (7% improvement between 2000 and 2009) (see measure&nbsp1.01).

Due to the small numbers involved it is not possible to detect statistically significant changes in specific causes of infant death. It may be that the improvements in infant mortal­ity are related to improvements in acute care for seriously ill new-born babies and in post-natal factors such as nutrition and growth, environment and infectious diseases, immunisation coverage and access to primary health and acute care. A study of avoidable mortality in the NT between 1985 and 2004 found the largest improvements in deaths were for conditions amenable to medical care such as increased number of births in hospital, improved neonatal and paediatric care and the establishment of prenatal screening for congenital abnormalities (Li et al. 2009a). The long-term study in the NT from 1967 found improvements in both neonatal deaths usually indicative of pregnancy related services and post-neonatal death (indicative of conditions) (Wang et al. 2010b).

In December 2007, COAG committed to closing the gap in Indigenous disadvantage, and in par­ticular, to halving the gap in mortality rates for Aboriginal and Torres Strait Islander children less than 5 years of age by 2018. Australian governments are investing in a range of initiatives to improve child and maternal health. Through the National Partnership Agreement on Indigenous Early Childhood Development, the Australian Government provides funding to state and territory governments for sexual health and young parent programs and funds 85 New Directions: Mothers and Babies Services which provide Aboriginal and Torres Strait Islander families with access to antenatal care; practical advice and assistance with parenting; and health checks for children.Top of page

Sids and Kids WA runs the Reducing the Risk of SIDS in Aboriginal Communities program to specifically target the high rates of SIDS among Indigenous infants. Aboriginal Coordinators educate and raise community awareness about preventative measures, such as safe sleeping practices. An evaluation of this program demonstrated the benefit of cultural security as an effective way to engage and empower hundreds of local professionals and members of Aboriginal communities across the state. The study recommended surveying health behaviours in Indigenous communities related to sudden infant death including co-sleeping and smoking tobacco during pregnancy and/or in an infant's environment. Additional Australian research on the prevalence of risk factors and their link to the higher rate of SIDS in Aboriginal and Torres Strait Islander babies would be very useful.